Application for Annulment of Marriage New York Supreme Court - PDF

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					Supreme Court of the State of New York
Appellate Division, Fourth Judicial Department
__________________________________________

In the Matter of the Application to Practice Law                Affidavit
        Under a Changed Name.
__________________________________________


STATE OF NEW YORK      )
COUNTY OF _____________) ss:

     ___________________________________, being duly sworn, deposes and says that:

1. I was admitted to the practice of law by the Appellate Division, Fourth Department,
on
   _________________under the name of ____________________________________.

2.   I currently reside at:
                              _________________________________________________
                              _________________________________________________

3.   I seek permission to change the name under which I practice law to:
     ____________________________________________________________________

4.   I have not been known by any names other than:
     ____________________________________________________________________

                                           or

     I have been known by the following other names:
     ____________________________________________________________________

5.   I seek to change the name under which I practice law for the following reasons:

       ____    Change in marital status (attach a copy of appropriate documentary proof
                [marriage certificate or license, judgement of divorce or annulment]).

       ____    Other legal name change (attach a copy of the court order and appropriate
               proof of compliance with the provisions of the order).
6.   I am in good standing and currently registered with the Office of Court
Administration.

7. I am not currently subject to either an outstanding order of discipline, or a pending
disciplinary investigation and to my knowledge there are no complaints of professional
misconduct filed against me.

8. No previous application to change the name under which I practice law has been made
(except as follows).
    ____________________________________________________________________

        WHEREFORE, I request that the name under which I am authorized to practice
law as recorded on the Roll of Attorneys and Counselors-at-Law on file in the Office of the
Clerk of this Court be changed as set forth above.



Dated: ____________________                 ___________________________________
                                                             Name


Sworn to before me this
_____ day of ______________, ______


________________________________
        Notary Public

				
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